Mapping Services at Two Nairobi County Primary Health Facilities: Identifying Challenges and Opportunities in Integrated Mental Health Care as a Universal Health Coverage (UHC) Priority

Abstract

Introduction: We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify available service resources, cadres, and developmental partners as well as existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care. We have tried to embrace the principles of integrating mental health services in primary care and keeping WHO mhGAP in mind. Additionally, primary care facilities’ capacity is a major limiting factor for expanding universal health coverage in low- and middle-income countries.

Method and Measures: This study utilized a qualitative evidence synthesis through semi-structured facility services mapping and stakeholder interviews. Services-related data was collected from two facility in-charges using the Nairobi City County Human Resource Health Strategy record forms. Additionally, we conducted 12 key informant interviews (KIIs) with and clinical officers (Clinicians at diploma level), Nurses, Community Health Assistants (CHAs), Prevention of Mother-to-child Transmission of HIV Mentor Mothers (PMTCTMs), around both general and adolescent mental health as well as psychosocial services they offered. Using the World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) as a guideline for the interview, all KII questions were structured to identify the extent of mental health integration in primary health care services. Interview transcripts were then systematically analyzed for common themes and discussed by the first three authors to eliminate discrepancies.

Results: Our findings show that health care services centered around physical health were offered daily while the mental health services were offered weekly through specialist services by the Ministry of Health directly or non-governmental partner. Despite Health care workers being aware of the urgent need to integrate mental health services into routine care, they expressed limited knowledge about mental health disorders, lack of trained mental health personnel, the need for more significant funding and resources to provide mental health services, and promotion of CMHS to treat mental health conditions in the primary care setting. Our stakeholders underscored the urgency of integrating mental health treatment, prevention, and well-being promotive activities targeting adolescents especially peripartum adolescent girls.

Conclusion: There is a need for further refining of the integrated care model in mental health services and targeted capacity building for health care providers to deliver quality services.